Posttraumatic stress disorder in general intensive care unit survivors: a systematic review☆
Abstract
Objective
Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD and the impact of post-ICU PTSD on health-related quality of life (HRQOL).
Methods
We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO and a hand-search of 13 journals.
Results
Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained “clinically significant” PTSD symptoms was 22% (n=1104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n=93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL.
Conclusions
The prevalence of PTSD in ICU survivors is high and negatively impacts survivors' HRQOL. Future studies should comprehensively address how patient-specific factors (e.g., pre-ICU psychopathology), ICU management factors (e.g., administration of sedatives) and ICU clinical factors (e.g., in-ICU delirium) relate to one another and to post-ICU PTSD. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients' needs for early intervention.
Keywords: Stress disorder, posttraumatic, Critical care, Intensive care unit, Risk factors, Outcome assessment (health care)
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☆ Dr. Needham is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research and by the National Institutes of Health (Acute Lung Injury SCCOR Grant # P050 HL73994). Dr. Bienvenu is supported by a Career Development Award from the National Institutes of Health (K23 MH64543).
PII: S0163-8343(08)00080-7
doi:10.1016/j.genhosppsych.2008.05.006
© 2008 Elsevier Inc. All rights reserved.
